Timely insight on cancer topics from the experts of the American Cancer Society

I've seen a few articles recently about removing the fallopian tubes to prevent ovarian cancer, a procedure called "prophylactic bilateral salpingectomy". And not just in women who are at high risk for ovarian cancer, which is already recommended by gynecological medical societies in the United States, but for all women who are not planning to have any more children and who are about to undergo abdominal surgery for any reason.

I can see the appeal given that many, if not most, ovarian cancers actually originate in the fallopian tubes. In fact, it is more common to find microscopic fallopian tube cancer than microscopic ovarian cancer in women with a BRCA1 or BRCA2 mutation when they have their ovaries and fallopian tubes removed. (These mutations put them at higher risk for ovarian and breast cancer.) And unfortunately we don't yet have an accurate test to screen women for ovarian cancer, so these cancers are usually found at a late stage when they are often fatal.

It is common for women to get their "tubes tied" (i.e. tubal ligation) as a form of permanent birth control, and we know this reduces the risk of ovarian cancer. But removing the fallopian tubes is a more invasive procedure, and the potential benefits and potential harms are largely unknown. Is it worth it? Does it really reduce the risk of ovarian cancer and, if so, by how much?

Risks vs. benefits not established

The Society of Gynecologic Oncology of Canada supports efforts to study the potential impact of fallopian tube removal on ovarian cancer risk across the population (as opposed to individual assessments with a particular woman). They currently recommend that women and doctors who are interested in this surgery discuss the potential risks and benefits. Some doctors are already encouraging all women who are seeking tubal ligation, hysterectomy, and other abdominal surgery to have their fallopian tubes removed as a preventive measure. But we don't really know what the risks and benefits are, because we don't have any real data.

Given the interest in removing fallopian tubes to prevent cancer, studies to determine the potential impact-both positive and negative-would be very helpful. Such studies would also be very difficult to do.

For one thing, it would require a prospective study - a study that starts tracking women before they have this procedure, and compares them to similar women who did not have the procedure. We can't look at women who have already had a hysterectomy and measure their risk of ovarian cancer, because at the time of their hysterectomy they either had both their fallopian tubes and ovaries removed or neither... so we can't measure risk among women who previously had their fallopian tubes removed (e.g. as part of a hysterectomy) because they would have also had their ovaries removed at the same time. And planning and carrying out a prospective study would take a very long time and a very large number of women. Because ovarian cancer is not very common and may not develop for years or decades after the surgery, it would take quite some time before we could get any meaningful results.

Another complicating factor is that hysterectomy without removing the fallopian tubes or ovaries already reduces ovarian cancer risk, by about the same amount as tubal ligation and taking oral contraceptives ("The Pill"). It would be extremely difficult to show in a study that removing the fallopian tubes would be more effective than tubal ligation or a hysterectomy without removal of the tubes, because there would already be fewer ovarian cancers in this group of women. On top of that, many of these women would have used oral contraceptives in the past.

As for the harms, the surgery would take a little longer than tubal ligation or hysterectomy, and the risk of complications, including risks of bleeding, infection, and reactions to the anesthesia, would be slightly higher because, for one reason, the risks increase as the length of surgery increases. There's a chance that, as with women who have a hysterectomy, removing the fallopian tubes would lead to women going through menopause earlier. One concern is that tube removal would interfere with the blood supply to the ovaries, which could prevent them from working as well, potentially leading to an increased risk of heart disease, stroke, and osteoporosis. But we don't have any data to help establish just what the risks of tube removal might be.

The bottom line

The bottom line is that there are no data showing whether or not removing the fallopian tubes only to prevent cancer will decrease ovarian cancer risk, although it seems logical that it should. For women having a hysterectomy or tubal ligation, there are no data showing that fallopian tube removal will reduce their risk beyond the extent to which it will be lowered from hysterectomy or tubal ligation that leaves the tubes in place. And we don't know what the risks of fallopian tube removal might be.

So what should women do? Ultimately, the choice to have fallopian tubes removed needs to be a personal decision made between a woman and her surgeon based on her risk of ovarian cancer and her personal preferences.